Medical debt-driven homelessness


The fictional 2007 television story depicting the plight of a widow with two daughters who, as a family, became homeless due to medical debt incurred during her since-deceased husband’s health care, is an eye-opener and heartbreaking. However, nowadays, the fact is emulating that fiction when statistics of homelessness risk due to medical debt are bewildering and shocking.

As compared to credit card debt, where buyers can at least gauge the maximum retail prices for received services and goods before paying with credit cards, even estimates of to-be-incurred medical debt remain undiscoverable to patients when being billed weeks to months after receiving services and procedures for their health care. Disclosures about to-be-incurred health care charges have not been available to patients until now, although the process of preauthorization has been available to their health care payers.

The process of preauthorization tries to balance the health care costs of allowing the health care services and procedures with the medicolegal costs of denying the health care services and procedures. If preauthorization is all about containing the costs to health care payers, health care providers and their health care places uniting against the cumbersomeness of preauthorization processes should not forget that patients are payers too, often paying partly when covered by high-premium low-deductible health plans, while sometimes paying fully when covered by low-premium high-deductible health plans.

Providers may think that their sole focus should be on the science of delivering health care to patients irrespective of its costs to patients and payers. However, their thinking may flip over when facing dwindling reimbursements and compensations secondary to unmanageable health care costs. Their oblivion might have been permissible if patients were to be commonly covered by low-premium low-deductible health plans because, as compared to individual patients, their health plans’ carriers have way stronger socioeconomic buffers to absorb the shocks of soaring health care charges and way powerful negotiating skills to disperse the aftershocks of dwindling health care reimbursements.

Essentially, even though the final health care charges can never be gauged preemptively due to the volatile fluidity of patients’ health care states and health care demands under the care of health care providers and their health care places, the best guesstimates should not be withheld from the patients, even when worrying that patients might choose to delay or even avoid receiving their health care. Socioeconomic hardships are sufferings too, which may routinely get overlooked and may often get worsened with undisclosed health care costs. Physically and maybe psychologically healthy patients may not survive their socioeconomic illnesses, and thus, patients needing health care services and procedures have the right to choose which illnesses they must overcome first and which illnesses they must not allow to worsen at certain points in their lives.

Health care providers and their health care places, well-accustomed to managing the chargeable services and procedures for only physical and maybe psychological health of patients, may have to disclose their own conflicts of interests if they are not able to address socioeconomic sufferings originating or worsening during health care delivery focused only on patients’ physical and maybe psychological health.

The bottom line is that preauthorization by patients themselves, as the evolving health care payers in the environments of high-premium high-deductible health plans, warrants preemptive disclosure to the patients about health care provider-place charges to the best of their guesstimate abilities while utilizing data-mined historical health care charge summaries to corroborate with artificially intelligent health care charge forecasts.

Deepak Gupta is an anesthesiologist.






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